Hydrocephalie post-meningitique du nourrisson a Dakar

Introduction L’étiologie post-infectieuse de l’hydrocéphalie varie entre 7 et 48 % et reste corrélée au niveau de santé de la population du pays considéré. Elle en constitue la principale cause dans les pays sous-développés. Cependant cette prédominance des hydrocéphalies post-infectieuses à tendance à s’atténuer, surtout chez le nourrisson avec un profil étiologique qui tend vers celui des pays développés. Cette étude a pour objectif de déterminer les raisons de cette diminution.Matériel et méthodes Il s’agit d’une étude rétrospective de 2004 à 2008, portant sur 91 nourrissons traités pour hydrocéphalie. Parmi eux, 42 avaient une origine post-méningitique. Le diagnostic d’hydrocéphalie post-méningitique a été établi sur les antécédents de méningite, la bactériologie du LCR et sur l’imagerie (TDM, ETF).Résultats L’étiologie post-méningitique représentait 46% des hydrocéphalies. L’âge moyen était de 7,6 mois. La couverture vaccinale optimale était notée dans 7 cas. On notait une prédominance de la méningite à heamophilus influenza avec une forte proportion des méningites à bactériologie négative (30 cas). Nous avons retrouvé dans 32 cas une hydrocéphalie tétraventriculaire. A long terme, seuls 5 enfants ont eu un développement psychomoteur satisfaisant.Conclusion L’étiologie post-méningitique des hydrocéphalies reste fréquente en dépit des efforts entrepris dans le domaine de la prévention. Mais beaucoup de progrès reste à faire dans son renforcement et dans la prise en charge précoce des méningites

Outcomes Associated With Intracranial Aneurysm Treatments Reported as Safe, Effective, or Durable:A Systematic Review and Meta-Analysis

Importance: Testing new medical devices or procedures in terms of safety, effectiveness, and durability should follow the strictest methodological rigor before implementation. Objectives: To review and analyze studies investigating devices and procedures used in intracranial aneurysm (IA) treatment for methods and completeness of reporting and to compare the results of studies with positive, uncertain, and negative conclusions. Data Sources: Embase, MEDLINE, Web of Science, and The Cochrane Central Register of Clinical Trials were searched for studies on IA treatment published between January 1, 1995, and the October 1, 2022. Grey literature was retrieved from Google Scholar. Study Selection: All studies making any kind of claims of safety, effectiveness, or durability in the field of IA treatment were included. Data Extraction and Synthesis: Using a predefined data dictionary and analysis plan, variables ranging from patient and aneurysm characteristics to the results of treatment were extracted, as were details pertaining to study methods and completeness of reporting. Extraction was performed by 10 independent reviewers. A blinded academic neuro-linguist without involvement in IA research evaluated the conclusion of each study as either positive, uncertain, or negative. The study followed Preferring Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Main Outcomes and Measures: The incidence of domain-specific outcomes between studies with positive, uncertain, or negative conclusions regarding safety, effectiveness, or durability were compared. The number of studies that provided a definition of safety, effectiveness, or durability and the incidence of incomplete reporting of domain-specific outcomes were evaluated.Results: Overall, 12 954 studies were screened, and 1356 studies were included, comprising a total of 410 993 treated patients. There was no difference in the proportion of patients with poor outcome or in-hospital mortality between studies claiming a technique was safe, uncertain, or not safe. Similarly, there was no difference in the proportion of IAs completely occluded at last follow-up between studies claiming a technique was effective, uncertain, or noneffective. Less than 2% of studies provided any definition of safety, effectiveness, or durability, and only 1 of the 1356 studies provided a threshold under which the technique would be considered unsafe. Incomplete reporting was found in 546 reports (40%).Conclusions and Relevance: In this systematic review and meta-analysis of IA treatment literature, studies claiming safety, effectiveness, or durability of IA treatment had methodological flaws and incomplete reporting of relevant outcomes supporting these claims.</p

Needs of Young African Neurosurgeons and Residents: A Cross-Sectional Study.

Introduction: Africa has many untreated neurosurgical cases due to limited access to safe, affordable, and timely care. In this study, we surveyed young African neurosurgeons and trainees to identify challenges to training and practice. Methods: African trainees and residents were surveyed online by the Young Neurosurgeons Forum from April 25th to November 30th, 2018. The survey link was distributed via social media platforms and through professional society mailing lists. Univariate and bivariate data analyses were run and a P-value < 0.05 was considered to be statistically significant. Results: 112 respondents from 20 countries participated in this study. 98 (87.5%) were male, 63 (56.3%) were from sub-Saharan Africa, and 52 (46.4%) were residents. 39 (34.8%) had regular journal club sessions at their hospital, 100 (89.3%) did not have access to cadaver dissection labs, and 62 (55.4%) had never attended a WFNS-endorsed conference. 67.0% of respondents reported limited research opportunities and 58.9% reported limited education opportunities. Lack of mentorship (P = 0.023, Phi = 0.26), lack of access to journals (P = 0.002, Phi = 0.332), and limited access to conferences (P = 0.019, Phi = 0.369) were associated with the country income category. Conclusion: This survey identified barriers to education, research, and practice among African trainees and young neurosurgeons. The findings of this study should inform future initiatives aimed at reducing the barriers faced by this group

Canal lombaire étroit par lipomatose épidurale: à propos d’un cas et revue de la littérature

La lipomatose épidurale est une pathologie caractérisée par une l'accumulation anormale de graisse non encapsulée dans l'espace épidural. Bien que rare, elle est une cause possible de lombosciatique ou de canal lombaire étroit. Elle est souvent associée à des facteurs favorisants tels qu'une corticothérapie prolongée, ou une obésité. Nous rapportons une observation d'un patient qui a présenté des lombosciatalgies invalidantes et dont l'exploration radiologique a confirmé une lipomatose épidurale compressive. L'évolution a été favorable après décompression chirurgicale.Mots clés: Canal lombaire étroit, lipomatose, chirurgieEnglish Title: Narrow lumbar channel due to epidural lipomatosis: case report and literature reviewEnglish AbstractEpidural lipomatosis is characterized by the abnormal accumulation of non-encapsulated grease in the epidural space. Although rare, it is a possible cause of lombosciatica or narrow lumbar channel. It is often associated with contributing factors such as prolonged corticosteroid therapy or obesity. We report the case of a patient presenting with disabling lombosciatalgias. Radiological evaluation confirmed the diagnosis of compressive epidural lipomatosis. Patient's evolution was favorable after surgical decompression.Keywords: Narrow lumbar channel, lipomatosis, surger

Endoscopic Treatment of Colloid Cysts of Third Ventricle: Study of Three Cases

Introduction: Colloid cyst of the third ventricle is a rare intracranial benign tumor. Traditionally, treatment is carried out by transcallosal or transcortical transventricular approach. Currently, the endoscopic treatment of these lesions is increasingly used. We reported our preliminary experience about three cases of colloid cysts treated by neuroendoscopy. Methods and Patients: We conducted a retrospective study on the analysis of medical records of three patients with colloid cyst who had been operated endoscopically in our department. We used a rigid neuroendoscope of 2.7 mm in diameter, with an optical 30°. Coagulation of the wall, followed by a puncture aspiration of cystic contents and partial resection of its wall were performed during the surgery. The mean follow-up time was two years. Results: Patients were 35, 47, and 53 years old. They were male. The dominant clinical symptom was headaches with consciousness disorder. Brain MRI allowed the diagnosis in all cases. The mean operation time was 100 minutes. A case of intraoperative hemorrhage was observed, necessitating the installation of an EDV. The outcome was favorable in two patients, and after surgery we observed one case of meningitis treated. One case of transient amnesia and one death were reported. Conclusion: Preliminary results of endoscopic treatment of colloid cysts were encouraging. It is a promising technique in our department. However, more investigation is necessary

Pituitary Abscess: a Report of Two Cases

Background and Importance: Abscess of the hypophysis or pituitary adenoma is a very rare entity, and its preoperative diagnosis could be challenging. The clinical presentation is less specific, and despite the recent advancement in imaging, diagnosis before surgery is still difficult. Case Presentation: We reported two cases of pituitary abscesses in patients aged 38 and 42 years. The first patient was managed for maxillary sinusitis associated with pituitary adenoma whose diagnosis was made following surgery. For the second patient, the diagnosis was proposed before surgery following an MRI which showed a ring enhancement lesion of the hypophysis. Both patients benefitted from surgery where one had sub-labial rhino-septal trans-sphenoidal approach and the other through endoscopic endonasal trans-sphenoidal approach. Both received intravenous broad spectrum antibiotics.   Conclusion:  Post-operative evolution was good with control MRI showing complete disappearance of the sellar lesion. Early diagnosis and treatment improved the prognosis

Hémangioblastome de l’angle ponto-cérébelleux : rapport de cas

L’hémangioblastome de l’angle ponto-cérébelleux (APC) est rare. Le diagnostic différentiel peut se poser avec le schwannome vestibulaire, car ces deux entités peuvent avoir des caractéristiques identiques à l’imagerie par résonance magnétique (IRM). L’exérèse des hémangioblastomes solides peut être difficile à cause de leur hypervascularisation et leur difficulté à la dissection circonférentielle. L’embolisation et la radiochirurgie préopératoire permettent de limiter le saignement per opératoire. Nous rapportons un cas d’hémangioblastome de l’angle ponto-cérébelleux, opéré 6 ans après une radiochirurgie par voie rétro- sigmoïdienne qui était considéré au départ comme un schwannome vestibulaire atypique.Mots clés : angle ponto-cérébelleux, Hémangioblastome.English AbstractHemangioblastoma of the cerebellopontine angle is very rare. The differential diagnosis is vestibular schwannoma, because these two entities can have identical characteristics to magnetic resonance imaging. Hemangioblastoma solids dissection can be very tough because it is highly vascularised and their difficulty in circumferential dissection. Embolization and radiosurgery preoperative is used to reduce operative bleeding. Here it’s a case report of a hemangioblastoma of the cerebellopontine angle surgery, six years after radiosurgery through retrosigmoidienne which was seen initially as an atypical vestibular Schwannoma.Key words: cerebellopontine angle, hemangioblastom